Patient positioning support structure

ABSTRACT

A patient support system includes independently adjustable columns supporting a hinged bending or breaking patient support structure. At least one column includes at least two sections. A coordinated drive system provides for upwardly breaking and downwardly breaking orientations of the two sections in various inclined and tilted positions.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No.13/902,466 filed May 24, 2013, which application is acontinuation-in-part of U.S. application Ser. No. 13/317,012 filed Oct.6, 2011, now U.S. Pat. No. 8,719,979, entitled Patient PositioningSupport Structure, which application is a continuation of U.S. Ser. No.12/460,702, filed Jul. 23, 2009, now U.S. Pat. No. 8,060,960, which is acontinuation of U.S. Ser. No. 11/788,513, filed Apr. 20, 2007, now U.S.Pat. No. 7,565,708, which claims the benefit of U.S. ProvisionalApplication No. 60/798,288 filed May 5, 2006 and is also acontinuation-in-part of U.S. patent application Ser. No. 11/159,494filed Jun. 23, 2005, now U.S. Pat. No. 7,343,635, which is acontinuation-in-part of U.S. patent application Ser. No. 11/062,775filed Feb. 22, 2005, now U.S. Pat. No. 7,152,261. The disclosures of allthe preceding applications and patents are incorporated by referenceherein.

BACKGROUND OF THE INVENTION

The present invention is directed to structure for use in maintaining apatient in a desired position during examination and treatment,including medical procedures such as imaging and surgery and inparticular to such a structure that allows a surgeon to selectivelyposition the patient for convenient access to the surgery site andproviding for manipulation of the patient during surgery including thetilting, pivoting, angulating or bending of a trunk of a patient in asupine, prone or lateral position.

Current surgical practice incorporates imaging techniques andtechnologies throughout the course of patient examination, diagnosis andtreatment. For example, minimally invasive surgical techniques, such aspercutaneous insertion of spinal implants, involve small incisions thatare guided by continuous or repeated intra-operative imaging. Theseimages can be processed using computer software programs that producethree dimensional images for reference by the surgeon during the courseof the procedure. If the patient support surface is not radiolucent orcompatible with the imaging technologies, it may be necessary tointerrupt the surgery periodically in order to remove the patient to aseparate surface for imaging followed by transfer back to the operatingsupport surface for resumption of the surgical procedure. Such patienttransfers for imaging purposes may be avoided by employing radiolucentand other imaging compatible systems. The patient support system shouldalso be constructed to permit unobstructed movement of the imagingequipment and other surgical equipment around, over and under thepatient throughout the course of the surgical procedure withoutcontamination of the sterile field.

It is also necessary that the patient support system be constructed toprovide optimum access to the surgical field by the surgery team. Someprocedures require positioning of portions of the patient's body indifferent ways at different times during the procedure. Some procedures,for example, spinal surgery, involve access through more than onesurgical site or field. Since all of these fields may not be in the sameplane or anatomical location, the patient support surfaces should beadjustable and capable of providing support in different planes fordifferent parts of the patient's body as well as different positions oralignments for a given part of the body. Preferably, the support surfaceshould be adjustable to provide support in separate planes and indifferent alignments for the head and upper trunk portion of thepatient's body, the lower trunk and pelvic portion of the body as wellas each of the limbs independently.

Certain types of surgery, such as orthopedic surgery, may require thatthe patient or a part of the patient be repositioned during theprocedure while in some cases maintaining the sterile field. Wheresurgery is directed toward motion preservation procedures, such as byinstallation of artificial joints, spinal ligaments and total discprostheses, for example, the surgeon must be able to manipulate certainjoints while supporting selected portions of the patient's body duringsurgery in order to facilitate the procedure. It is also desirable to beable to test the range of motion of the surgically repaired orstabilized joint and to observe the gliding movement of thereconstructed articulating prosthetic surfaces or the tension andflexibility of artificial ligaments and other types of dynamicstabilizers before the wound is closed. Such manipulation can be used,for example, to verify the correct positioning and function of animplanted prosthetic disc or joint replacement during a surgicalprocedure. Where manipulation discloses binding, sub-optimal position oreven crushing of the adjacent vertebrae, for example, as may occur withosteoporosis, the prosthesis can be removed and the adjacent vertebraefused while the patient remains anesthetized. Injury which mightotherwise have resulted from a “trial” use of the implantpost-operatively will be avoided, along with the need for a second roundof anesthesia and surgery to remove the implant or prosthesis andperform the revision, fusion or corrective surgery.

There is also a need for a patient support surface that can be rotated,articulated and angulated so that the patient can be moved from a proneto a supine position or from a prone to a 90° position and wherebyintra-operative extension and flexion of at least a portion of thespinal column can be achieved. The patient support surface must also becapable of easy, selective adjustment without necessitating removal ofthe patient or causing substantial interruption of the procedure.

For certain types of surgical procedures, for example spinal surgeries,it may be desirable to position the patient for sequential anterior andposterior procedures. The patient support surface should also be capableof rotation about an axis in order to provide correct positioning of thepatient and optimum accessibility for the surgeon as well as imagingequipment during such sequential procedures.

Orthopedic procedures may also require the use of traction equipmentsuch as cables, tongs, pulleys and weights. The patient support systemmust include structure for anchoring such equipment and it must provideadequate support to withstand unequal forces generated by tractionagainst such equipment.

Articulated robotic arms are increasingly employed to perform surgicaltechniques. These units are generally designed to move short distancesand to perform very precise work. Reliance on the patient supportstructure to perform any necessary gross movement of the patient can bebeneficial, especially if the movements are synchronized or coordinated.Such units require a surgical support surface capable of smoothlyperforming the multi-directional movements which would otherwise beperformed by trained medical personnel. There is thus a need in thisapplication as well for integration between the robotics technology andthe patient positioning technology.

While conventional operating tables generally include structure thatpermits tilting or rotation of a patient support surface about alongitudinal axis, previous surgical support devices have attempted toaddress the need for access by providing a cantilevered patient supportsurface on one end. Such designs typically employ either a massive baseto counterbalance the extended support member or a large overhead framestructure to provide support from above. The enlarged base membersassociated with such cantilever designs are problematic in that they mayobstruct the movement of C-arm mobile fluoroscopic imaging devices.Surgical tables with overhead frame structures are bulky and may requirethe use of dedicated operating rooms, since in some cases they cannot bemoved easily out of the way. Neither of these designs is easily portableor storable.

Thus, there remains a need for a patient support system that provideseasy access for personnel and equipment, that can be easily and quicklypositioned and repositioned in multiple planes without the use ofmassive counterbalancing support structure, and that does not requireuse of a dedicated operating room.

SUMMARY OF THE INVENTION

The present invention is directed to a patient support system thatpermits adjustable positioning, repositioning and selectively lockablesupport of a patient's head and upper body, lower body and limbs in upto a plurality of individual planes while permitting tilting, rotation,angulation or bending and other manipulations as well as full and freeaccess to the patient by medical personnel and equipment. The system ofthe invention includes at least one support end or column that is heightadjustable. The illustrated embodiment includes a pair of independentlyheight-adjustable end support columns. The columns may be independent orconnected to a horizontally length-adjustable base. One support columnaccording to the invention may be coupled with a wall mount or otherstationary support. A patient support structure is connected to andbridges substantially between the pair of end supports. The supportstructure may be a frame or other patient support having at least firstand second hingeable or pivotally connected portions, the first andsecond portions being selectively lockable in a first substantiallyplanar orientation along a longitudinal axis of the support structure.The first and second portions are also positionable and lockable in aplurality of angles with respect to one another, with each portion beingmovable to a position on either side of the first planar orientation. Inother words, the patient support structure is capable of hinging orotherwise bending to form an angulation or break, either upwardly ordownwardly when the support structure is in a substantially horizontalposition and also when the support structure is in an inclined positiondue to one of the support columns raising one end of the structurehigher than another end. Of course, such a break may be fromside-to-side when the support structure is rotated about a longitudinalaxis thereof.

In a particular illustrated embodiment, angulation or breaking of thesupport structure is supported by a cable drive system (tension bandsuspension) that supports angulation using stationary end supports.Other embodiments include cantilevered systems with connected orunconnected movable or telescoping base supports. The first and secondsupport structure portions may be in the form of frames, such asrectangular frames or other support structure that may be equipped withsupport pads for holding the patient, or other structure, such asimaging tops.

The patient support structure and the support column or columns arecoupled with respective rotation, articulation or angulation adjustmentstructure for positioning the first support portion with respect to afirst column or end support and with respect to the second supportportion and the second support portion with respect to the second columnor end support. Rotation adjustment structure in cooperation withpivoting and height adjustment structure provide for the lockablepositioning of the first and second patient support portions at avariety of selected positions and articulations with respect to thesupport columns including angulation coupled with Trendelenburg andreverse Trendelenburg configurations as well as providing for patientroll over in horizontal or tilted orientation. Lateral movement (towardand away from a surgeon) may also be provided by a bearing blockfeature. A pair of patient support structures (such as a support frameand an imaging table) may be mounted between end supports of theinvention and then rotated in unison about a longitudinal axis toachieve 180° repositioning of a patient, from a prone to a supineposition.

Various objects and advantages of this invention will become apparentfrom the following description taken in relation to the accompanyingdrawings wherein are set forth, by way of illustration and example,certain embodiments of this invention.

The drawings constitute a part of this specification, include exemplaryembodiments of the present invention, and illustrate various objects andfeatures thereof.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of a patient support structure according tothe invention.

FIG. 2 is an enlarged and partial side elevational view of a portion ofthe support structure of FIG. 2.

FIG. 3 is an enlarged and partial top plan view of the support structureof FIG. 1.

FIG. 4 is an enlarged and partial perspective view of a portion of thestructure of FIG. 1.

FIG. 5 is an enlarged and partial side elevational view of a portion ofthe structure of FIG. 1.

FIG. 6 is an enlarged and partial perspective view of a portion of thestructure of FIG. 1.

FIG. 7 is an enlarged and partial perspective view of a first hinge ofthe structure of FIG. 1.

FIG. 8 is an enlarged and partial perspective view of a cooperatingsecond hinge of the structure of FIG. 1.

FIG. 9 is an enlarged and partial elevational view of the hinge of FIG.7.

FIG. 10 is an enlarged and partial perspective view of an outer portionof the hinge of FIG. 7 with portions broken away to show the detailthereof.

FIG. 11 is an enlarged and partial perspective view of an inner portionof the hinge of FIG. 7 with portions broken away to show the detailthereof.

FIG. 12 is an enlarged and partial perspective view of a portion of thestructure of FIG. 1 showing a cable drive motor and winch cylinders.

FIG. 13 is a partial perspective view of a patient support frame of thestructure of FIG. 1.

FIG. 14 is a partial perspective view of a patient imaging top forreplacement with the patent support frame of FIG. 13.

FIG. 15 is a reduced perspective view of the structure of FIG. 1 shownwith an imaging top of FIG. 14 replacing the support frame of FIG. 13and shown in a planar inclined position.

FIG. 16 is a perspective view of the structure of FIG. 15 shown in aplanar tilted position.

FIG. 17 is a perspective view of the structure of FIG. 15 shown in aplanar inclined and tilted position.

FIG. 18 is a side elevational view of the structure of FIG. 15 shown ina symmetrical upward breaking position.

FIG. 19 is a side elevational view of the structure of FIG. 15 shown ina first inclined and upward breaking position.

FIG. 20 is a side elevational view of the structure of FIG. 15 shown ina second inclined and upward breaking position.

FIG. 21 is a side elevational view of the structure of FIG. 15 shown ina symmetrical downward breaking position.

FIG. 22 is a side elevational view of the structure of FIG. 15 shown ina first inclined and downward breaking position.

FIG. 23 is a side elevational view of the structure of FIG. 15 shown ina second inclined and downward breaking position.

FIG. 24 is an enlarged side elevational view of the structure of FIG. 1shown in an upward breaking, inclined and tilted position.

FIG. 25 is a is a perspective view of a second embodiment of a patientsupport structure according to the invention.

FIG. 26 is a perspective view of the patient support structure of FIG.25 shown tilted in an intermediate position during a rotation as wouldbe used for a patient rollover.

FIG. 27 is a perspective view of the structure of FIG. 25 shown furthertilted in a second intermediate position during rotation.

FIG. 28 is a perspective view of the structure of FIG. 25 shown afterrotation to a final flipped position.

FIG. 29 is a front elevational view of a third embodiment of a patientsupport structure according to the invention.

FIG. 30 is a front elevational view of a fourth embodiment of a patientsupport structure according to the invention.

FIG. 31 is a perspective view of a fifth embodiment of a patient supportstructure according to the invention shown in a planar inclinedposition.

FIG. 32 is a perspective view of the structure of FIG. 31 shown in aninclined and upward breaking position.

FIG. 33 is a perspective view of the structure of FIG. 31 shown in asubstantially symmetrical downward breaking position.

DETAILED DESCRIPTION OF THE ILLUSTRATED EMBODIMENTS

As required, detailed embodiments of the present invention are disclosedherein; however, it is to be understood that the disclosed embodimentsare merely exemplary of the invention, which may be embodied in variousforms. Therefore, specific structural and functional details disclosedherein are not to be interpreted as limiting, but merely as a basis forthe claims and as a representative basis for teaching one skilled in theart to variously employ the present invention in virtually anyappropriately detailed structure.

Referring now to the drawings, a patient positioning support structureaccording to the invention is generally designated by the referencenumeral 1 and is depicted in FIGS. 1-12. The structure 1 includes firstand second upright support piers or columns 3 and 4 which areillustrated as independent, stationary floor base support structures asshown in FIG. 1 or may be connected to one another by a non-telescopingbase support as illustrated in the embodiment shown in FIGS. 25-28. Insome embodiments according to the invention as shown, for example, inFIGS. 31-33, the base connection places the columns in a selectivelytelescoping relationship. It is also foreseen that in certainembodiments according to the invention, one of the support columns maybe replaced by a conventional operating table support, or may even be awall mount. In the illustrated embodiment, the upright support column 3is connected to a first support assembly, generally 5, and the uprightsupport column 4 is connected to a second support assembly, generally 6.Between them, the support assemblies 5 and 6 uphold an elongate andangulatable or breaking patient holding or support structure, generally10 and optionally, a removable patient support structure that will bedescribed with respect to another embodiment of the invention. Theillustrated support structure 10 includes a first frame section 12, asecond frame section 14 with a transverse support cross bar 15, and apivot or hinge assembly, generally 16. In the illustrated embodiment,the pivot assembly further includes a cable drive system including adual winch 18 and cooperating cables 20.

The columns 3 and 4 are supported by outwardly extending feet 22 thatmay or may not include spaced apart casters or wheels (not shown) eachequipped with a floor-lock foot lever for lowering the feet 12 into afloor-engaging position as shown in FIG. 1. The columns 3 and 4 eachinclude two or more telescoping lift arm segments 3 a, 3 b and 4 a, 4 b,respectively that permit the height of each of the columns 3 and 4 to beselectively increased and decreased in order to raise and lower all or aselected portion of the connected patient support structure 10. It isforeseen that the vertical supports 3 and 4 may be constructed so thatthe column 3 has a greater mass than the support column 4 or vice versain order to accommodate an uneven weight distribution of the human body.Such reduction in size at the foot end of the system 1 may be employedin some embodiments to facilitate the approach of personnel andequipment.

Each of the support assemblies 5 and 6 generally includes a rotationsubassembly 26 and 26′ and an angulation subassembly 27 and 27′,respectively, that are interconnected as will be described in greaterdetail below and include associated power source and circuitry linked toa controller 29 (FIG. 1) for cooperative and integrated actuation andoperation. The rotational subassemblies 26 and 26′ enable coordinatedrotation of the patient support structure 10 about a longitudinal axis.The angulation subassemblies 27 and 27′ enable the selective hinging orbreaking of the support 10 by the hinge assembly 16 at desired levelsand increments as well as selective tilting of the longitudinal axis ofthe frame portion 12 or 14.

The rotation subassembly or mechanism 26 is shown in FIG. 5 and includesat least one motor housing 30 surmounting the support column 3. In theillustrated embodiment, only one rotational motor is provided, but it isforeseen that a cooperating motor may also be mounted on the supportcolumn 4. A main rotational shaft 32 extends from the motor housing 30that turns a rotation structure 33. The rotation structure 33 in turnrotates the connected patient support 10 about a longitudinal axis aswill be described in greater detail below. The motor housing 30 containsa rotary electric motor or other actuator drivingly engaged with theshaft 32. The rotation mechanism 26 is operated by actuating the motorusing a switch or other similar means. The rotation structure 33 isfixed to the shaft 32 at a location spaced from the motor housing 30 andthe support column 3 to provide clearance for rotation of the connectedpatient support structure 10.

As shown in FIG. 5, the rotation structure 33 is attached to a pair oftranslation posts or H-bar posts 40 disposed at either end of therotation structure 33. The posts 40 are each attached to the structure33 by a pin 42, bolt, or other fixing structure. A plurality ofcooperating apertures 44 formed in the posts 40 provide passageway for apivot pin 46 to extend therethrough. The pivot pin 46 is receivable ineach cooperating pair of apertures 44 allowing for selective placementof a translation connector 48 that is sized and shaped to be receivedbetween the pair of posts 40 and also receive the pivot pin 46therethrough. The pin 46 and connector 48 are thus positionable in anorientation transverse to the longitudinal extension of the support 10at a variety of heights to be selected by the surgeon and readilychangeable, even during surgery if necessary, to vary the height of theframe section 12. The multiple location or height feature is alsoadvantageous when more than one frame or patent structure is mounted intandem as shown, for example in FIGS. 25-28. The position of the frameor other structure may be desirably changed to provide close proximityto an imaging top with a distance between a patient support and animaging top being expandable or reduceable depending upon the size orother attributes of a patient and surgical or other requirements. Asillustrated in FIG. 5, the connector 48 has a slot 50 for receiving thepivot pin 46.

The translation connector 48 is in turn attached to a pivot connector52. The pivot connector 52 includes first and second outwardly openingand opposed slots 54 and 56. The first slot 54 is sized and shaped forreceiving the translation connector 48 and the second slot is sized andshaped for receiving an end connection 58 of the frame section 12. Thepivot connector 52 further includes a through aperture or bore 60running substantially perpendicular to the slot 54 and communicatingtherewith. The aperture 60 is sized and shaped to receive a pivot pin 62therethrough, allowing for some forward and rearward lateral movement ofthe attached frame end connection 58 and thus the frame section 12,providing a degree of freedom and clearance needed for rotation thepatient support about a longitudinal axis of a patient. The slot 56 issized and shaped to frictionally engage the frame end connection 58,thus securely fixing the end connection 58 to the pivot connector 52.The frame end connection 58 is in turn fixed to each of elongate framemembers 66 and 68 of the frame section 12. The frame members 66 and 68are each hingedly connected to the hinge assembly 16 to be described ingreater detail below. Pivoting of the translation connector 48 withrespect to the pin 46 provides for selected articulation of the framesection 12 (that includes the end connection 58 and the frame members 66and 68) and/or the entire support 10 with respect to the support pier orcolumn 3.

With reference to FIG. 6, at the support pier or column 4, the supportassembly 6 is substantially similar to the support assembly 5 with theexception that the rotation subassembly 26′ is passive and thereforedoes not include a motor. However, the support pier or column 4preferably includes a powered mechanism to provide selective heightadjustment of the subassembly 26′. A rotation structure 33′ is spacedfrom and freely rotatable with respect to the column 4. The structure33′ includes a shaft (not shown) extending outwardly therefrom similarto the rotation shaft 32, the shaft being rotatingly received in anaperture in the support column 4.

The rotation subassembly 26′ and the angulation subassembly 27 otherwiseinclude elements identical to or substantially similar to the elementsof the subassemblies 26 and 27. Specifically, H-bar posts 40′, pin 42′,apertures 44′, pivot pin 46′, translation connector 48′, slot 50′, pivotconnector 52′, end connector 58′ and pivot pin 62′, are identical orsubstantially similar in form and cooperate with other elementsidentically or substantially similarly to what has been describedpreviously herein with respective H-bar posts 40, pin 42, apertures 44,pivot pin 46, translation connector 48, slot 50, pivot connector 52, endconnector 58 and pivot pin 62.

The frame 14 further includes frame members 66′ and 68′ that are eachfixed to the end connector 58′. The frame members 66′ and 68′ arepivotably or hingedly connected to respective frame members 66 and 68 bythe hinge assembly 16. Specifically, the frame member 66 is attached tothe frame member 66′ by the hinge mechanism 70 and the frame member 68is attached to the frame member 68′ by the hinge mechanism 72. Withparticular reference to FIGS. 7 and 9-11, the hinge mechanism 70includes, an outer member 76 and an inner member 78. The outer member 76is fixed or may be integral with the elongate frame member 66, while theinner member 78 is integral or otherwise fixed to the frame member 66′.The outer member 76 further includes an extension 80 with a groove 82for receiving and guiding the cable 20. The extension 89 tapers in adirection from the outer member interior 84 to the groove 82. Theextension 89 is configured to cause a slight upward break or bend of thesupport 10 when the extension 89 comes into contact with the cable 20 atthe groove 82. In that way, when the cables 20 are reeled in to shortenthe hypotenuse of the triangle formed by the cable, the section 12 andthe section 14, the sections 12 and 14 move toward one another,resulting in the upward break as illustrated, for example, in FIG. 18.The downward break illustrated, for example, in FIG. 21 is a result oflengthening the cable 20 distance and allowing gravity to drop the hinge70. The extension 89 is shaped to extend slightly inwardly toward alongitudinal axis A of the support 10, thereby guiding the cable 20along a path within a periphery of the frame sections 12 and 14 when theextension 89 is in contact with the cable 20 when in a downward breakingconfiguration directed toward the cable with the cable 20 being receivedat the groove 82.

It is foreseen that where an upward breaking (only) embodiment isdesired according to the invention, the sections 12 and 14 may bepositioned with respect to two end columns to always include a slightupward break or bend at the hinge or pivot between the sections 12 and14. When the telescoping base is actuated to move the columns toward oneanother, the sections 12 and 14 would automatically further breakupwardly and toward one another. Downward breaking would not be possiblein such an embodiment as the maximum distance between the two endcolumns would still ensure a slight upward break or hinge between thesections 12 and 14. Such an embodiment would be acceptable for usebecause patient holding pads could be positioned on the frames 12 and 14such that the patient would be in a substantially horizontal positioneven when there is a slight upward bend or break at the hinge betweenthe sections 12 and 14.

Returning to the hinge 70 of illustrated embodiment, the inner member 78is slidingly and rotatably receivable in an interior 84 of the outermember 76. The outer member has a pair of pivot apertures 86 and theinner member has a pivot aperture 87, the apertures cooperating tocreate a through bore for receiving a pivot pin 88 through both theinner and outer hinge members. The interior 84 includes a curvedpartially cylindrical surface 89 for slidingly receiving a cooperatingouter rounded and partially cylindrical surface 90 of the inner member78. The inner member 78 further includes a downward breaking stop orprojection 92 that limits a downward pivot (in a direction toward thecables 20) of the hinge 70 in the event the cables 20 should fail. Thestop 92 abuts against a surface 93 of the interior 84. In theillustrated embodiment, the stop 92 limits the extent of rotation orhinging of the section 66 with respect to the section 66′ to abouttwenty-five degrees. Upward pivot (in a direction away from the cables20) is limited by abutment of an inner planar surface 95 with a planarsurface 96 of the hinge inner member 78.

With particular reference to FIG. 8, the hinge mechanism 72 issubstantially a minor image of the hinge mechanism 70 and thereforeincludes the following elements: a hinge outer member 76′, and innermember 78′, and extension 80′ with a groove 82′, and interior 84′ pivotapertures 86′ and 88′, a pivot pin 88′, a curved surface 89′, and outersurface 90′, a stop 92′, an abutment surface 93′, an inner planarsurface 95′ and a planar surface 96′. These elements are substantiallysimilar in shape and function to the respective hinge outer member 76,inner member 78, extension 80, groove 82, interior 84, pivot apertures86 and 88, pivot pin 88, curved surface 89, outer surface 90, stop 92,abutment surface 93, inner planar surface 95 and planar surface 96described herein with respect to the hinge 70.

It is noted that other hinge or pivot mechanisms may be utilized in lieuof the hinge assembly 16. For example, the polyaxial joint 95illustrated and described in Applicant's pending U.S. patent applicationSer. No. 11/062,775 filed Feb. 22, 2005, and pending U.S. patentapplication Ser. No. 11/159,494 filed Jun. 23, 2005, may be incorporatedinto the patient support structure 10 at the break between the sections12 and 14. Both of these U.S. applications (Ser. Nos. 11/062,775 and11/159,494) are hereby incorporated by reference herein.

The cable drive system 18 includes a rotary motor 98 cooperating withand driving by rotation a pair of winch cylinders 99 disposed on eitherside of the motor 98. The motor 98 and cylinders 99 are mounted to theend connector 58′ located near the support column 4. Each cable 20 isattached to one of the winch cylinders 99 at one end thereof and to theend connector 58 at the other end thereof. In a first longitudinalposition wherein the section 12 is substantially planar with the section14, the cables 20 are wound about the winch cylinders 99 an amount toprovide enough tension in the cables 20 to maintain such a substantiallyplanar orientation and configuration, with the hinge extensions 82 and82′ being in contact with each of the cables 20. The motor 98 ispreferably low speed and high torque for safely winding both of thecables 20 simultaneously about the cylinders 99 to draw the section 12toward the section 14 to result in an upward breaking configuration withthe hinges 70 and 72 disposed in spaced relation with the cables 20 andthe hinges 70 and 72. The motor 98 may be reversed, reversing thedirection of rotation of the winch cylinders 99 for slowly unwinding thecables 20 to a downward breaking configuration. As the cables 20 unwind,gravity draws the support sections 12 and 14 downward with the cables 20being received in the grooves 82 and 82′ of the hinge extensions 80 and80′. As the cables 20 slacken, the hinges 70 and 72 continue to lowerpressing down upon the cables 20.

It is noted that the frame sections 12 and 14 are typically equippedwith pads (not shown) or other patient holding structure. Furthermore,with respect to FIGS. 13 and 14, the frame member sections 66 and 68 ofsection 12 and the frame member sections 66′ and 68′ of the section 14may be replaced with substantially rectangular imaging tops or sections100 and 101′ respectively. Each of the sections 100 and 101′ havingelongate slots 101 formed therein to allow for attachment of the hingemechanisms 70 and 72 in a manner identical or substantially similar towhat has been described herein with respect to the frame sections 12 and14.

With reference to FIGS. 15-17, the imaging sections 100 and 100′ areillustrated, replacing the frame sections 12 and 14 of the embodimentdisclosed in FIGS. 1-12. Each of FIGS. 15-17 represent configurations inwhich the cable drive 18 is tensioned such that the sections 100 and100′ are kept in a substantially coplanar configuration. FIG. 15illustrates a configuration in which the column 3 is telescoped upwardlywith the frame sections hinging at the support assemblies 5 and 6,resulting in an inclined position or configuration of the entire patientsupport. In the illustrated embodiment, the section 100 would preferablyreceive a patient's head. Therefore, FIG. 15 illustrates a reverseTrendelenburg position or orientation. FIG. 16 illustrates the sections100 and 100′ again in a substantially common plane with both sectionsbeing rotated to a tilted position produced by a powered rotation of therotation the sub assemblies 26 and passive rotation of the assembly 26′with both columns 3 and 4 otherwise holding the sections 100 and 100′ atthe same height. FIG. 17 illustrates both tilting due to rotation of theassemblies 26 and 26′ and also a sloping or inclined position with thecolumn 4 being extended vertically. Thus, FIG. 17 illustrates aTrendelenburg position or orientation with both the sections 100 and100′ remaining in substantially the same plane.

With reference to FIGS. 18-20, there is illustrated three upwardbreaking or hinging configurations of the structure 1. FIG. 18illustrates a symmetrical upward breaking configuration wherein thecolumns 3 and 4 are holding the respective support assemblies 5 and 6 atsubstantially the same height with the cables 20 being shortened byrotation of the winch motor to result in an upward break in the hingeassembly 16. FIG. 19 illustrates the column 3 being extended to amaximum height and the cables reeled to shorten a distance between thesections 100 and 100′. An example of such an upward break with reverseTrendelenburg would be a head or column 3 height of 43 inches, a foot orcolumn 4 height of 24 inches and a 35 degree upward break with zerodegree roll. FIG. 20 illustrates an upward breaking Trendelenburg withthe column 4 being extended to a maximum height.

With reference to FIGS. 21-23, there is illustrated three downwardbreaking configurations of the structure 1. FIG. 21 illustrates asymmetrical downward breaking configuration wherein the columns 3 and 4are holding the support assemblies 5 and 6 respectively, at the sameheight with the cables 20 being unwound or slackened to result in adownward break in the hinge assembly 16, the hinges 70 and 72 contactingthe cables 20. FIG. 22 illustrates a downward breaking reverseTrendelenburg with the column 3 being extended to a maximum heightresulting in a patent's head end being at a maximum height. FIG. 23illustrates a downward breaking Trendelenburg with the column 4 beingextended to a maximum height.

It is noted that in each of the configurations illustrated in FIGS.18-23, the sub assemblies 26 may be rotated in either direction,resulting in a tilted or rotated as well as upwardly or downwardlybroken or hinged configuration. For example, FIG. 24 illustrates thestructure 1 with support frame sections 12 and 14 positioned in aconfiguration similar to that illustrated in FIG. 19, but also includingrotation, resulting in a tilting and upwardly breaking configuration ofthe structure 1. An example of the position illustrated in FIG. 24 wouldbe: a head or column 3 height of 41 inches, a foot or column 4 height of34 inches and a 35 degree upward break with 10 degree roll.

With reference to FIGS. 25-28, another structure, generally 102according to the invention is illustrated. The structure 102 utilizesall of the elements described herein with respect to the structure 1 andtherefore the same references numerals are used for the same elements orfeatures. The structure 102 differs from the structure 1 in that theH-bar posts 40 and 40′ are replaced or modified to be extended H-barposts 40A and 40A′, allowing for the mounting of two elongate structure10 and cooperating cable drives 18. In the embodiment shown in FIG. 25,one of the structures 10 includes the frame member 12 and 14 while theother structure is an imaging top having sections 100 and 100′. Aspreviously described herein, the cooperating H-bar posts 40A and 40A′equipped with a plurality of apertures allows for the placement of thesupport structures 10 at a variety of locations. As illustrated in FIGS.25-28, the structure 102 provides for the complete rotation and thus aroll-over of a patient by actuation of the motor of the rotationsubassembly 26 using the controller 29. The structure 102 is furtherillustrated with a non-telescoping base support 110 fixed to each of thecolumns 3 and 4 and rollers or castors 112 at the base of the structure102.

With reference to FIGS. 29 and 30, another embodiment or systemaccording to the invention, generally 200 is illustrated. The system 200broadly includes an elongate length-adjustable base 202 surmounted ateither end by respective first and second upright support piers orcolumns 203 and 204 which are connected to respective first and secondsupport assemblies, generally 205 and 206. Between them, the supportassemblies 205 and 206 uphold an elongated breaking, hingeable orpivotable patient support structure, generally 210. The structure isdescribed in detail in Applicants's pending U.S. patent application Ser.No. 11/062,775 filed Feb. 22, 2005, Ser. No. 11/159,494 filed Jun. 23,2005, both of which are incorporated by reference herein. The embodiment200A illustrated in FIG. 30 differs from the structure 200 only in thatthe length-adjustable base 202 is replaced by a first base 220 attachedto the pier 203 and a second base 222 attached to the pier 204. All ofthe bases 202, 220 and 222 include castors or rollers 230 or some othermovable structure to allow the piers 203 and 204 to move toward and awayfrom one another during upward or downward breaking of the structure210.

It is foreseen that cable drives as described herein, other types ofmotor drives including screw drives, hydraulic systems, and the like,may be utilized to facilitate both upward and downward breaking of thesupport structure 210.

Another patient support structure according to the invention, generally301, is illustrated in FIGS. 31-33. The structure 301 generally includesa horizontally telescoping floor mounted base 302, a conventional orstandard telescoping and inclinable operating table support structure304, a telescoping end support or pier 306 and a hinged or pivotallyupwardly and downwardly breaking support structure 310 connected to boththe structure 304 and the pier 306. The patient support structure 310further includes a first cantilevered section 312 and a second section314. The first section 312 is fixed to and extends from the operatingtable support 304. The second section is attached to the pier 306 by ahinge or pivoting assembly 320, such as the support assembly 5 describedherein with respect to the structure 1. The hinge mechanism 316 disposedbetween the support sections 312 and 314 may be a conventional hinge,pivot, or pivot or hinge systems previously described herein.

In use, the operating table support 304 utilizes electric or other powermeans to move the support section 312 up and down and at an incline, asis known in the art. In response to the movement of the section 312, thesection 314 also moves, resulting in upward and downward breakingillustrated in FIGS. 32 and 33. In response to the movement of thesection 312, the electric powered telescoping base 302 moves the pier306 toward or away from the support 304. The pier 306 includes a motorfor raising and lowering the pier at the connection 320.

As stated above with respect to other embodiments of the inventiondescribed herein, it is foreseen that cable drives as described herein,other types of drives including screw drives, hydraulic systems, and thelike, may be utilized to facilitate both upward and downward breaking ofthe support structure 310.

It is to be understood that while certain forms of the present inventionhave been illustrated and described herein, it is not to be limited tothe specific forms or arrangement of parts described and shown.

What is claimed and desired to be secured by Letters Patent is asfollows:
 1. A surgical table comprising: a first vertical support and asecond vertical support spaced-apart from the first vertical support;and a patient support extending between the first and second verticalsupports and configured to articulate intermediate a length of thepatient support and comprising a first end and a second end opposite thefirst end, wherein each end of the first and second ends is operablycoupled to its respective vertical support of the first and secondvertical supports to: i) pivot in a direction transverse to the lengthof the patient support; and ii) both pivot relative to the respectivevertical support about an axis transverse to the length of the patientsupport and displace relative to the respective vertical support in adirection of the length of the patient support when the patient supportarticulates intermediate its length.
 2. The surgical table of claim 1,wherein the patient support comprises a joint intermediate the length ofthe patient support and about which the patient support articulates. 3.The surgical table of claim 2, wherein the patient support comprises afirst segment extending between the first end and the joint and a secondsegment extending between the second end and the joint, the first andsecond segments both comprising an open-frame configuration defined bytransversely spaced-apart longitudinally extending frame members.
 4. Thesurgical table of claim 2, further comprising a drive system thatactively drives the joint in articulating the patient support about thejoint.
 5. The surgical table of claim 1, wherein a coupling arrangementresponsible for operably coupling each end and its respective verticalsupport comprises a rotation assembly and an angulation assembly.
 6. Thesurgical table of claim 5, wherein the angulation assembly isresponsible for each end both pivoting about the axis transverse to thelength and displacing in the direction of the length of the patientsupport, and the rotation assembly is responsible for each end pivotingin the direction transverse to the length.
 7. The surgical table ofclaim 6, wherein the rotation assembly pivotally couples the angulationassembly to the respective vertical support.
 8. The surgical table ofclaim 6, wherein the rotation assembly is located between the respectivevertical support and the angulation assembly.
 9. The surgical table ofclaim 1, wherein, when displacing relative to the respective verticalsupport in a direction of the length of the patient support when thepatient support articulates intermediate its length, each end moves awayfrom its respective vertical support when the patient supportarticulates into an increasingly folded configuration.
 10. The surgicaltable of claim 1, wherein, when displacing relative to the respectivevertical support in a direction of the length of the patient supportwhen the patient support articulates intermediate its length, each endmoves towards its respective vertical support when the patient supportarticulates into a decreasingly folded configuration.
 11. The surgicaltable of claim 1, further comprising a first pivot shaft located betweenthe first end and first vertical support, the first pivot shaft enablingthe first end to pivot in the direction transverse to the length of thepatient support.
 12. The surgical table of claim 11, further comprisinga second pivot shaft located between the second end and second verticalsupport, the second pivot shaft enabling the second end to pivot in thedirection transverse to the length of the patient support.
 13. Thesurgical table of claim 12, wherein each shaft of the first and secondpivot shafts extends directly from the respective vertical support. 14.The surgical table of claim 1, wherein the surgical table is configuredsuch that each end of the first and second ends is independentlyadjustable with respect to height.
 15. The surgical table of claim 1,wherein each vertical support of the first and second vertical supportsis independently adjustable with respect to height so as to cause eachend of the first and second ends to be independently adjustable withrespect to height.
 16. The surgical table of claim 14, wherein eachvertical support of the first and second vertical supports comprises atelescopic configuration.
 17. The surgical table of claim 1, furthercomprising a coupling arrangement at each of the respective verticalsupports, the coupling arrangement being at least partially responsiblefor operably coupling each end and its respective vertical support, thecoupling arrangement comprising a pivot pin coaxial with the axistransverse to the length of the patient support and about which each endrespectively pivots.
 18. The surgical table of claim 17, wherein thecoupling arrangement further comprises a member including a slot inwhich the pivot pin is received, the slot displacing along the pivot pinas each end displaces relative to the respective vertical support in adirection of the length of the patient support when the patient supportarticulates intermediate its length.
 19. The surgical table of claim 1,wherein, when each end is operably coupled to its respective verticalsupport to pivot in a direction transverse to the length of the patientsupport, the end is capable of a complete rotation.
 20. The surgicaltable of claim 1, wherein, when the patient support articulatesintermediate the length of the patient support, a distance between thefirst and second vertical supports does not change.
 21. A surgical tablecomprising: a first vertical support and a second vertical supportspaced-apart from the first vertical support by a distance; and apatient support extending between the first vertical support and thesecond vertical support and comprising a first end, a second endopposite the first end, and a joint between the first end and the secondend, the patient support configured such that the first end and thesecond end are capable of articulating relative to each other at thejoint, wherein the first end is operably coupled to the first verticalsupport to: i) pivot in a direction transverse to the distance; and ii)both pivot relative to the first vertical support about a first axisthat is transverse to the distance and displace relative to the firstvertical support along the distance when the first and second endsarticulate relative to each other at the joint, and wherein the secondend is operably coupled to the second vertical support to: i) pivot inthe direction transverse to the distance; and ii) both pivot relative tothe second vertical support about a second axis that is transverse tothe distance and displace relative to the second vertical support alongthe distance when the first and second ends articulate relative to eachother at the joint.
 22. The surgical table of claim 21, wherein surgicaltable is configured such that the distance does not change when thefirst and second ends articulate relative to each other at the joint.23. The surgical table of claim 21, wherein the patient supportcomprises a first section extending between the first end and the jointand a second section extending between the second end and the joint, thefirst and second sections both comprising an open-frame configurationdefined by transversely spaced-apart longitudinally extending framemembers.
 24. The surgical table of claim 21, further comprising a drivesystem that actively drives the joint in articulating the patientsupport about the joint.
 25. The surgical table of claim 21, furthercomprising a drive system comprising a cable extending along the patientsupport and acting across the joint.
 26. The surgical table of claim 21,wherein the first end is operably coupled to the first vertical supportvia a first coupling arrangement, and the second end is operably coupledto the second vertical support via a second coupling arrangement. 27.The surgical table of claim 26, wherein, on account of the first andsecond coupling arrangements, the patient support is able to articulateat the joint without a change in the distance.
 28. The surgical table ofclaim 26, wherein: a) the first coupling arrangement comprises a firstrotation assembly and a first angulation assembly, wherein: i) the firstend pivots relative to the first vertical support in the direction thatis transverse to the distance via the first rotation assembly; and ii)when the first and second ends articulate relative to each other at thejoint, the first end pivots via the first angulation assembly relativeto the first vertical support about the first axis that is transverse tothe distance, and the first end displaces relative to the first verticalsupport along the distance via the first angulation assembly; and b) thesecond coupling arrangement comprises a second rotation assembly and asecond angulation assembly, wherein: i) the second end pivots relativeto the second vertical support in the direction that is transverse tothe distance via the second rotation assembly; and ii) when the firstand second ends articulate relative to each other at the joint, thesecond end pivots via the first angulation assembly relative to thesecond vertical support about the second axis that is transverse to thedistance, and the second end displaces relative to the second verticalsupport along the distance via the second angulation assembly.
 29. Thesurgical table of claim 28, wherein, on account of the first and secondangulation assemblies, the patient support is able to articulate at thejoint without a change in the distance.
 30. The surgical table of claim28, wherein at least the first angulation assembly or the secondangulation assembly is passively driven.
 31. The surgical table of claim28, wherein at least the first rotation assembly or the second rotationassembly is actively driven.
 32. The surgical table of claim 31, whereinin being actively driven, the at least the first rotation assembly orthe second rotation assembly comprises a motor driven shaft that causesat least the first end to pivot relative to the first vertical supportin the direction that is transverse to the distance or the second end topivot relative to the second vertical support in the direction that istransverse to the distance.
 33. The surgical table of claim 28, whereinat least a portion of the first coupling arrangement or the secondcoupling arrangement is actively driven.
 34. The surgical table of claim33, wherein the at least a portion of the first coupling arrangement orthe second coupling arrangement comprises the first or second rotationassembly.
 35. The surgical table of claim 28, wherein at least one thefollowing is true: i) the first rotation assembly is located between thefirst vertical support and the first angulation assembly; or ii) thesecond rotation assembly is located between the second vertical supportand the second angulation assembly.
 36. The surgical table of claim 21,wherein when the patient support articulates intermediate its lengthinto an increasingly folded configuration, the first end moves away fromthe first vertical support and the second end moves away from the secondvertical support.
 37. The surgical table of claim 21, wherein when thepatient support articulates intermediate its length into an decreasinglyfolded configuration, the first end moves towards the first verticalsupport and the second end moves towards the second vertical support.38. The surgical table of claim 21, further comprising a first pivotshaft located between the first end and first vertical support, thefirst end pivoting in the direction transverse to the distance via thefirst pivot shaft.
 39. The surgical table of claim 38, furthercomprising a second pivot shaft located between the second end andsecond vertical support, the second end pivoting in the directiontransverse to the distance via the second pivot shaft.
 40. The surgicaltable of claim 39, wherein the first pivot shaft extends directly fromthe first vertical support, and the second pivot shaft extends directlyfrom the second vertical support.
 41. The surgical table of claim 21,wherein the surgical table is configured such that the first end and thesecond end are independently adjustable with respect to height.
 42. Thesurgical table of claim 41, wherein the first vertical support and thesecond vertical support are independently adjustable with respect toheight so as to cause the first end and the second end to beindependently adjustable with respect to height.
 43. The surgical tableof claim 42, wherein at least one of the first vertical support and thesecond vertical support comprises a telescopic configuration.
 44. Thesurgical table of claim 21, further comprising: a first couplingarrangement being at least partially responsible for operably couplingthe first end and the first vertical support, the first couplingarrangement comprising a first pivot pin coaxial with the first axistransverse to the distance and about which the first end pivots; and asecond coupling arrangement being at least partially responsible foroperably coupling the second end and the second vertical support, thesecond coupling arrangement comprising a second pivot pin coaxial withthe second axis transverse to the distance and about which the secondend pivots.
 45. The surgical table of claim 44, wherein the firstcoupling arrangement further comprises a member including a slot inwhich the first pivot pin is received, the slot displacing along thefirst pivot pin as the first end displaces relative to the firstvertical support along the distance when the patient support articulatesintermediate its length.
 46. The surgical table of claim 21, wherein,when each end of the first and second ends is operably coupled to itsrespective vertical support of the first and second vertical supports topivot in a direction transverse to the distance, each end being capableof complete rotation.